Provider Demographics
NPI:1730575416
Name:LIKELY, RAYVEN (RPH)
Entity type:Individual
Prefix:
First Name:RAYVEN
Middle Name:
Last Name:LIKELY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W MARTIN LUTHER KING HWY
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-2131
Mailing Address - Country:US
Mailing Address - Phone:334-727-6586
Mailing Address - Fax:334-727-9590
Practice Address - Street 1:202 W MARTIN LUTHER KING HWY
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-2131
Practice Address - Country:US
Practice Address - Phone:334-727-6586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19473183500000X
AL7801188390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program